Provider Demographics
NPI:1598911364
Name:VVG-RX
Entity Type:Organization
Organization Name:VVG-RX
Other - Org Name:VVG/RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERITZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-916-0346
Mailing Address - Street 1:3030 N FRESNO ST
Mailing Address - Street 2:STE 107
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3030 N FRESNO ST
Practice Address - Street 2:STE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1124
Practice Address - Country:US
Practice Address - Phone:559-227-7726
Practice Address - Fax:559-227-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY490893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5631470OtherNCPDP PROVIDER IDENTIFICATION NUMBER